Insurers: The back end of still isn't working

A perfect follow-up to the “are these people really enrolled or aren’t they?” post earlier. The White House is working on two fixes right now: One is the website, of course, and the other is its political problem with Democratic incumbents. They want people signing up this month but they also want things to be as stress-free for skittish Dems as possible — and they’re willing to trade a little on the former to shore up the latter. That’s why they’re nudging lefty groups not to do any big enrollment campaigns in December even though that would help the White House get closer to its enrollment target. If liberals go all out to get people to log on and the site crashes again, O might lose the Pryors and Landrieus in Congress irretrievably. Even slow, below-target enrollment is okay to him if it gives Democrats a few months’ breather from any new hair-tearing embarrassments.

A question per the Times, though: What if the back end of the site, where application data and subsidy reimbursements are transmitted to insurers, still doesn’t work? Answer: Lots of stress in January. Lots.

While insurers will start covering people who pay their share of the premium, many insurers worry the government will be late on the payments they were expecting in mid-January for the first people covered.

“We want to be paid,” said one executive, speaking frankly on the condition of anonymity. “If we want to pay claims, we need to get paid.”

Insurers said they had received calls from consumers requesting insurance cards because they thought they had enrolled in a health plan through the federal website, but the insurers said they had not been notified.

“Somehow people are getting lost in the process,” the insurance executive said. “If they go to a doctor or a hospital and we have no record of them, that will be very upsetting to consumers.”

That’s not the extent of it. Insurers are still receiving duplicate applications in some cases and in others the applicants themselves are receiving bad info on whether they’re entitled to a subsidy, a potentially catastrophic problem for O-Care in that it risks making rate shock even worse. Kaiser Health News describes one woman who somehow managed to log onto in October only to be told that she was ineligible for subsidies. According to Kaiser’s own calculations, though, based on her income she should be entitled to $292 a month or nearly $3,600 a year, an enormous difference to a middle-class family. Even worse, her husband has a serious illness so she’s desperate to have her coverage and subsidy in place on January 1. And yet, despite having mailed a written appeal to HHS in early November, she’s heard nothing. But it could be worse: Imagine being one of the people referenced in the NYT excerpt above who think they’ve successfully enrolled because the front end of the site is telling them they’re done — while the back end of the site has no record of them. Those people will start making doctor appointments for January in the expectation that they’re covered. Who wants to man the phones in Mark Pryor’s or Mary Landrieu’s office when people start calling to say they showed up at the doctor’s office only to be told by the receptionist that their insurer has no record of them?

All of this is only going to make the “if you like your plan” fallout worse, since of course some significant portion of people who are desperate to sign up right now are those who received cancellation notices over the past few months. Can the new and allegedly improved process them over the next three weeks so that they have no lapse in coverage? Kaiser wonders:

“The challenge ahead is you have a lot of people who need to get into the system,” said Sarah Lueck, an analyst with the Center on Budget and Policy Priorities, a Washington think tank that focuses on issues related to low- and moderate-income people…

Prompt enrollment is urgent for people in several circumstances. Some have no coverage, either because they haven’t been able to afford it or, like Momi, because they have pre-existing medical issues that led insurers to reject them in the past. Some have insurance that is going to expire. That group includes people whose health plans have been canceled and those in a high-risk pool that is closing. For people with serious medical issues, such as cancer patients in the middle of treatment, the loss of coverage could be medically and financially devastating.

So here’s the outlook for the next eight weeks. Even with the White House urging progressive nonprofits not to drum up extra interest in enrollment before December 23rd in order to keep site traffic manageable, traffic is still bound to soar. The site may well crash, right in the home stretch before the December 23rd deadline. Once December 23rd arrives, insurers will have just eight days to somehow process the last-minute crush of applications without error, even though some unknown portion of them will likely be riddled with data problems from If/when the applications are processed, people will start discovering next month after they’ve made appointments that their insurer has never heard of them. They’ll also find out that that the relatively low-premium ObamaCare “bronze” plan they signed up for happens to come with a deductible that’s stratospherically high and a provider network that’s much smaller than they’d hoped for. And on top of all that, it’s an open question whether the risk pools in the exchanges will be as young and healthy as insurers need them to be or whether they’ll end up too old or sick to be sustainable. In other words — mass chaos. Like I say, this is merely the next eight weeks. How long will Democrats tough it out?

I wonder if we’ll reach the point where HHS starts politely encouraging enrollees to phone their insurer after they’ve ostensibly enrolled on and, er, make sure that the company has a record of them. That’d be humiliating, but less humiliating than having those people discover that next month. That’s really all this is for the White House at this point — a process of balancing time against lesser or greater humiliations. They spent the last six weeks focusing on the front end of the site, even though they knew the risk of catastrophe if the back end wasn’t fixed, because it was more important to show the public that improvements were being made. If they’d fixed the back end while consumers languished in 404 hell, it might have chased congressional Dems away. Now they’re going to try to fix the back end over the next month or two knowing that insurers have bought into this scheme to the point where they have no choice but to be patient. This is triage not just in the technological sense but in the political sense. How much more blood can Democrats lose before they pull the plug? Exit quotation from Obama, the thinking-man’s answer to the notoriously “incurious” George Bush: “We’re evaluating why it is exactly that I didn’t know soon enough that it wasn’t going to work the way it needed to.”